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Ayoub D, Al-Hajje A, Salameh P, Jost J, Hmaimess G, Nasreddine W, Jaafar F, Wazne J, Bitar R, Sabbagh S, Boumediene F, Beydoun A. Early predictors of remission in children and adolescents with new-onset epilepsy: A prospective study. Seizure 2023; 110:69-77. [PMID: 37327752 DOI: 10.1016/j.seizure.2023.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023] Open
Abstract
PURPOSE This study aims to identify predictive factors of a two-year remission (2YR) in a cohort of children and adolescents with new-onset seizures based on baseline clinical characteristics, initial EEG and brain MRI findings. METHODS A prospective cohort of 688 patients with new onset seizures, initiated on treatment with antiseizure medication was evaluated. 2YR was defined as achieving at least two years of seizure freedom during the follow-up period. Multivariable analysis was performed and recursive partition analysis was utilized to develop a decision tree. RESULTS The median age at seizure onset was 6.7 years, and the median follow-up was 7.4 years. 548 (79.7%) patients achieved a 2YR during the follow up period. Multivariable analysis found that presence and degree of intellectual and developmental delay (IDD), epileptogenic lesion on brain MRI and a higher number of pretreatment seizures were significantly associated with a lower probability of achieving a 2YR. Recursive partition analysis showed that the absence of IDD was the most important predictor of remission. An epileptogenic lesion was a significant predictor of non-remission only in patients without evidence of IDD, and a high number of pretreatment seizures was a predictive factor in children without IDD and in the absence of an epileptogenic lesion. CONCLUSION Our results indicate that it is possible to identify patients at risk of not achieving a 2YR based on variables obtained at the initial evaluation. This could allow for a timely selection of patients who require close follow-up, consideration for neurosurgical intervention, or investigational treatments trials.
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Affiliation(s)
- Dana Ayoub
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France; Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Amal Al-Hajje
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Pascale Salameh
- Clinical and Epidemiological Research Laboratory, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, 2417, Nicosia, Cyprus; School of Medicine, Lebanese American University, Lebanon
| | - Jeremy Jost
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Ghassan Hmaimess
- Department of Pediatrics, St George Hospital Medical University Center, University of Balamand, Beirut, Lebanon
| | - Wassim Nasreddine
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fatima Jaafar
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaafar Wazne
- Rafic Hariri University Hospital, Beirut, Lebanon
| | - Ribal Bitar
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sandra Sabbagh
- Department of Pediatrics, Hotel Dieu de France Hospital, Beirut, Lebanon
| | - Farid Boumediene
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Ahmad Beydoun
- Department of Neurology, American University of Beirut Medical Center, Beirut, Lebanon.
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Ojha V. Association between Clinical Features and Magnetic Resonance Imaging Findings in Patients with Temporal Lobe Epilepsy. JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2022. [DOI: 10.5005/japi-11001-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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3
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Dzefi-Tettey K, Edzie EM, Brakohiapa E, Kekessie K, Piersson A, Acheampong F, Gorleku P, Nixon H, Asemah A, Kusodzi H. Seizures in children: Spectrum of findings on brain magnetic resonance imaging at the Korle Bu Teaching Hospital, Ghana. WEST AFRICAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.4103/wajr.wajr_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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4
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Hourani R, Nasreddine W, Dirani M, Hmaimess G, Sabbagh S, El Tourjuman O, Wazne J, Toufaili H, AlArab N, El Dassouki M, Beydoun A. When Should a Brain MRI Be Performed in Children with New-Onset Seizures? Results of a Large Prospective Trial. AJNR Am J Neuroradiol 2021; 42:1695-1701. [PMID: 34244128 DOI: 10.3174/ajnr.a7193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/05/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is a paucity of data regarding the incidence of structural brain lesions in children with new-onset unprovoked seizures. Our aim was to determine the frequencies and types of epileptogenic lesions detected on a dedicated epilepsy protocol MR imaging according to age group, the presence of developmental delay, and the number and types of seizures. MATERIALS AND METHODS Consecutive children between 6 months and 18 years of age with new-onset unprovoked seizures were included. The frequencies and types of epileptogenic lesions were determined and then stratified according to sex, age groups, the presence of developmental delay, and the number and types of seizures at presentation. Multivariate analysis was used to identify variables significantly associated with the presence of epileptogenic lesions. RESULTS One thousand children were included. An epileptogenic lesion was identified in 26%, with malformations of cortical development being the most common lesion (32%), followed by hypoxic-ischemic injury (20%) and vascular etiologies (16%). Univariate analysis showed a significant increase in the frequency of epileptogenic lesions with decreasing age, the presence of developmental delay, and the number and types of seizures at presentation. The presence of developmental delay and seizure type at presentation remained significant in a multivariate analysis. CONCLUSIONS We documented a relatively high rate of epileptogenic lesions in children with new-onset seizures, with the presence of developmental delay and specific seizure types being associated with a higher likelihood of detecting an epileptogenic lesion on neuroimaging. This study fulfills the requirements of the study design recommended by the Practice Committee of the American Academy of Neurology, and we hope that our results will assist the relevant societies and committees in formulating neuroimaging guidelines for children with new-onset seizures.
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Affiliation(s)
- R Hourani
- Department of Radiology (R.H., N.A.), American University of Beirut Medical Center, Beirut, Lebanon
| | - W Nasreddine
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
| | - M Dirani
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
| | - G Hmaimess
- Department of Pediatrics (G.H.), St George Hospital Medical University Center, University of Balamand, Beirut, Lebanon
| | - S Sabbagh
- Department of Pediatrics (S.S.), Hotel Dieu de France Hospital, Beirut, Lebanon
| | - O El Tourjuman
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - J Wazne
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - H Toufaili
- Labib Medical Center (H.T.), Beirut, Lebanon
| | - N AlArab
- Department of Radiology (R.H., N.A.), American University of Beirut Medical Center, Beirut, Lebanon
| | - M El Dassouki
- Department of Neurology (O.E.T., J.W., M.E.D.), Rafic Hariri University Hospital, Beirut, Lebanon
| | - A Beydoun
- Department of Neurology (W.N., M.D., A.B.), American University of Beirut Medical Center, Beirut, Lebanon
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Nezami A, Tarhani F, Shoshtari NK. Organic Lesions in the Brain MRI of Children with Febrile Seizure. Curr Med Imaging 2021; 17:148-154. [PMID: 32101131 DOI: 10.2174/1573405616666200226103615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Seizure is the most common neurological disorders in children, where 4-10% of the cases experience at least one seizure before the age of 16. The most frequent causes of seizures in children are fever, epilepsy, infection and brain damage. The aim of this study was to investigate the frequency of organic lesions in MRI of children with seizures unrelated to fever. MATERIALS AND METHODS This cross-sectional study included children presented with fever-unrelated seizures. The MRI was examined by a radiologist to identify abnormal findings in each patient. A researcher-made questionnaire including general information, history of head trauma, obstructed labor and the history of seizure was completed for the patients. RESULTS Of 287 children with fever-related seizure, 127 (45.7%) were male and 151 (54.3%) were female. History of seizure, history of obstructed labor, abnormal MRI, complete delay, use of antiepileptic drug and history of trauma were 22(9.9%), 1 (0.4%), 11(4%), 5(1.8%), 259(93.2%) and 12 (4.3%), respectively. Of 11 patients with abnormal MRI, 4 had MTS lesions, 2 had tumor lesions, 2 had scarring trauma, 1 had an epidural abscess and 1 had meningitis. The frequency of organic lesions had no significant differences based on gender, use of antiepileptic drug and traumatic history, but it had a significant relation with obstructed labor andthehistory of seizure. CONCLUSION The results showed that organic brain lesions in children with fever-unrelated seizure had a significant relationship with the history of seizure and obstructed maternal labor.
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Affiliation(s)
- Alireza Nezami
- Department of Cardiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fariba Tarhani
- Department of Cardiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
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Suzuki M, Jin K, Kitazawa Y, Fujikawa M, Kakisaka Y, Sato S, Mugikura S, Nakasato N. Diagnostic yield of seizure recordings and neuroimaging in patients with focal epilepsy without interictal epileptiform discharges. Epilepsy Behav 2020; 112:107468. [PMID: 33181891 DOI: 10.1016/j.yebeh.2020.107468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Repeated routine electroencephalography (EEG) or even long-term video-EEG monitoring (VEM) does not always record interictal epileptiform discharges (IEDs) in some patients with epilepsy. The present study investigated whether focal seizures detected by VEM and focal abnormalities on neuroimaging are useful for the diagnosis of patients with focal epilepsy without IEDs. METHODS We retrospectively reviewed 409 consecutive patients with focal epilepsy (207 men, aged 9 to 76 years) who underwent 4- or 5-day VEM, magnetic resonance imaging (MRI), and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) for diagnosis to identify patients without IEDs. The occurrence of focal seizures during VEM and the presence of focal abnormalities on neuroimaging were investigated in those patients. The occurrence rate of seizures during VEM was investigated in patients with daily, weekly, monthly, and yearly seizure frequency based on history-taking. RESULTS Ninety-five (23.2%) of 409 patients with focal epilepsy did not have IEDs. Fifty-five (57.9%) of the 95 patients had focal seizures during VEM. Fifty-four patients (56.8%) showed focal abnormalities compatible with seizure semiology on neuroimaging investigations. Neither seizure recordings nor neuroimaging abnormalities were seen in 16 (16.8%) of the 95 patients. The occurrence rate of seizures during VEM depended on the seizure frequency at history-taking. However, 28 (45.9%) of 61 patients with monthly and yearly seizure frequency had focal seizures during 4- or 5-day VEM with seizure induction. CONCLUSIONS Video-EEG monitoring can detect focal seizures in patients with focal epilepsy but no IEDs. Comprehensive assessment including VEM and neuroimaging study is important for the diagnosis.
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Affiliation(s)
- Minori Suzuki
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kazutaka Jin
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Yu Kitazawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Neurology and Stroke Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
| | - Mayu Fujikawa
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan; Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yosuke Kakisaka
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shiho Sato
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nobukazu Nakasato
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Tokatly Latzer I, Orbach R, Ben-Sira L, Mezad-Koursh D, Bachar Zipori A, Roth J, Constantini S, Fattal-Valevski A, Lubetzky R. The Clinical Utility of Inpatient Brain Magnetic Resonance Imaging in Children. J Child Neurol 2020; 35:744-752. [PMID: 32517554 DOI: 10.1177/0883073820931264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The clinical applicability and yield of brain magnetic resonance imaging (MRI) in the setting of an inpatient pediatric department has not been investigated. The authors performed a retrospective chart review of nontraumatic/nonneurosurgical children who underwent brain MRI during their hospitalization in a general pediatric department over a 5-year period. Of the 331 children who underwent brain MRI, 148 (45%) had abnormal findings. High-risk headaches and focal seizures were significantly correlated with findings on brain MRI. Diagnostic and therapeutic yields were most significant in acute demyelinating events, acute cerebrovascular disorders, high-risk headaches when supported by neurologic and ophthalmologic findings, focal seizures with evidence of multifocal epileptic activity on an electroencephalogram and ophthalmic complaints when accompanied by cranial nerve palsy and optic nerve impairment. Since the contributions of a brain MRI in hospitalized children is pivotal in specific clinical situations, a judicious decision-making process should be done before its scheduling, in order to optimize clinical care.
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Affiliation(s)
- Itay Tokatly Latzer
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel
| | - Rotem Orbach
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel
| | - Liat Ben-Sira
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Radiology Unit, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Ophthalmology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Anat Bachar Zipori
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Pediatric Ophthalmology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jonathan Roth
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatric Neurosurgery and 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shlomi Constantini
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatric Neurosurgery and 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, 26745Tel-Aviv University, Israel.,These authors have contributed equally to this work
| | - Ronit Lubetzky
- Sackler School of Medicine, 26745Tel-Aviv University, Israel.,Department of Pediatrics, 108403Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv, Israel.,These authors have contributed equally to this work
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Pearce K, Dixon L, D'Arco F, Pujar S, Das K, Tahir Z, Tisdall M, Mankad K. Epilepsy surgery in children: what the radiologist needs to know. Neuroradiology 2020; 62:1061-1078. [PMID: 32435887 DOI: 10.1007/s00234-020-02448-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/27/2020] [Indexed: 12/18/2022]
Abstract
This review updates the radiologist on current epilepsy surgery practice in children, with a specific focus on the role of imaging in pre-surgical work-up, current and novel surgical techniques, expected post-surgical imaging appearances and important post-operative complications. A comprehensive review of the current and emerging international practices in paediatric epilepsy surgical planning and post-operative imaging is provided with details on case-based radiological findings. A detailed discussion of the pathophysiology and imaging features of different epileptogenic lesions will not be discussed as this is not the objective of this paper. Epilepsy surgery can be an effective method to control seizures in certain children with drug-resistant focal epilepsy. Early surgery in selected appropriate cases can lead to improved cognitive and developmental outcome. Advances in neurosurgical techniques, imaging and neuroanaesthesia have driven a parallel expansion in the array of epilepsy conditions which are potentially treatable with surgery. The range of surgical options is now wide, including minimally invasive ablative procedures for small lesions such as hypothalamic hamartomata, resections for focal lesions like hippocampal sclerosis and complex disconnective surgeries for multilobar conditions like Sturge Weber Syndrome and diffuse cortical malformations. An awareness of the surgical thinking when planning epilepsy surgery in children, and the practical knowledge of the operative steps involved will promote more accurate radiology reporting of the post-operative scan.
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Affiliation(s)
- Kirsten Pearce
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Luke Dixon
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Suresh Pujar
- Department of Neurology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Krishna Das
- Department of Neurology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Zubair Tahir
- Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Martin Tisdall
- Department of Neurosurgery, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital NHS Foundation Trust, Great Ormond St, London, WC1N 3JH, UK.
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Minh Xuan N, Khanh Tuong TT, Quang Huy H, Huu Son N. Magnetic Resonance Imaging Findings and Their Association with Electroencephalogram Data in Children with Partial Epilepsy. Cureus 2020; 12:e7922. [PMID: 32377499 PMCID: PMC7198078 DOI: 10.7759/cureus.7922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background It is important to identify the neuroimaging features that are associated with partial epilepsy in children. Advances in technology have recently been made to localize focal epileptogenic lesions, especially high-resolution structural imaging with magnetic resonance imaging (MRI). The recommendation that electroencephalography (EEG) should be the gold standard and that MRI should be optional has been questioned. The present study aims to evaluate the efficacy of MRI in children with partial epilepsy and to compare the diagnostic yields of MRI and EEG data. Methods The present study was conducted among one hundred twelve 1- to 6-year-old children with partial epilepsy. All patients underwent EEG and brain MRI. The epileptogenic lesions were identified on the basis of the signal intensities and morphological abnormalities seen on MRI. The correlation between MRI and EEG abnormal findings was analyzed using a chi-square test. Results Abnormal MRI findings were present in 34.8% (n = 39) of the sample. The EEG and MRI data agreed with respect to classifications into abnormal or normal in 48.2% of the sample (n = 54). Of the 27 patients with normal EEG findings, six (22.2%) had abnormal MRI findings. Inter-rater agreement showed the compatibility between EEG and MRI not significant (weighted Kappa = 0.105). Conclusion A number of MRI abnormalities were found in our study of otherwise normal children, although the correlation between these results was not clear. The follow-up of these children will help us identify the important abnormalities. Despite the small sample size, our results showed that normal EEG findings do not predict normal brain MRI data in children with partial epilepsy.
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Affiliation(s)
- Ngo Minh Xuan
- Pediatrics, Pham Ngoc Thach University of Medicine, Ho Chi Minh, VNM
| | | | - Huynh Quang Huy
- Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh, VNM
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Abstract
Zusammenfassung
Je nach Anfallssemiologie und EEG-Befund werden Epilepsien klinisch zumeist in fokale bzw. generalisierte Formen unterteilt. Tritt bei einem Kind infolge einer Epilepsie zusätzlich eine Entwicklungsstörung auf, kann dies oft auf eine epileptische Enzephalopathie zurückgeführt werden. Das Mutationsspektrum genetischer Epilepsien ist ausgesprochen heterogen und kann am besten mithilfe der Hochdurchsatzsequenzierung erfasst werden. Insbesondere bei den Enzephalopathien besteht eine hohe Aufklärungsrate. Mittlerweile gibt es für diverse genetisch bedingte Epilepsieerkrankungen individualisierte Therapien, die auf den jeweiligen molekularen Pathomechanismus abzielen, und die Zahl solcher personalisierter Therapieoptionen steigt stetig.
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Affiliation(s)
- Johannes R. Lemke
- 1 grid.411339.d 0000 0000 8517 9062 Institut für Humangenetik Universitätsklinikum Leipzig Ph.-Rosenthal-Str. 55 04103 Leipzig Deutschland
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11
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Guerriero RM, Gaillard WD. Imaging modalities to diagnose and localize status epilepticus. Seizure 2019; 68:46-51. [DOI: 10.1016/j.seizure.2018.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 01/07/2023] Open
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Møller RS, Hammer TB, Rubboli G, Lemke JR, Johannesen KM. From next-generation sequencing to targeted treatment of non-acquired epilepsies. Expert Rev Mol Diagn 2019; 19:217-228. [DOI: 10.1080/14737159.2019.1573144] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Rikke S. Møller
- Department of Epilepsy Genetics and Precision Medicine, The Danish Epilepsy Centre, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Trine B. Hammer
- Department of Epilepsy Genetics and Precision Medicine, The Danish Epilepsy Centre, Dianalund, Denmark
| | - Guido Rubboli
- Department of Epilepsy Genetics and Precision Medicine, The Danish Epilepsy Centre, Dianalund, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Johannes R. Lemke
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Katrine M. Johannesen
- Department of Epilepsy Genetics and Precision Medicine, The Danish Epilepsy Centre, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
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Sum MY, Low K, Tang PH. General anesthesia / sedation requirement influences the way MRI brain scans are ordered in a tertiary pediatric hospital. J Magn Reson Imaging 2018; 49:e250-e255. [PMID: 30390374 DOI: 10.1002/jmri.26551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/06/2018] [Accepted: 10/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND MRI guidelines have been created to help clinicians order scans appropriately. Some scans in children are carried out under general anesthesia (GA) / sedation. PURPOSE To evaluate if the requirement for GA/sedation influences the way MRI brain scans are ordered. STUDY TYPE Retrospective. POPULATION Children with MRI brain scans in 2015 to 2017. FIELD STRENGTH 3T, 1.5T. ASSESSMENT Institutional Review Board approval for waiver of consent was obtained. Clinical MRI brain reports for children were classified into whether they conformed to the American College of Radiology (ACR) 2013 guidelines by research assistants under supervision of a pediatric radiologist. Scans were sorted into those with normal brains or abnormality. STATISTICAL TEST The statistical difference between groups was assessed using t-test for continuous variables and chi-square test for categorical variables with IBM SPSS 19. RESULTS Of the total 1893 MRI scans, 431 were performed under GA and six under sedation. Of the 431 cases performed under GA/sedation, 383 (87.6%) were ordered according to guidelines. Of the 1456 cases that did not require GA/sedation, 710 (48.8%) conformed to guidelines. The percentage of scans ordered according to guidelines was 38.8% higher in those who had scans performed under GA/sedation (P < 0.001). MRI scans were normal in 635 (58.0%) out of the 1093 cases ordered according to guidelines and normal in 638 (79.8%) out of the 800 cases that did not follow guidelines. Scans not ordered according to guidelines had higher proportion of normal scans (21.8%) compared with those ordered according to guidelines (P < 0.001). DATA CONCLUSION Higher adherence to imaging guidelines is seen in younger patients who were exposed to the risks of GA/sedation for the MRI. Scans not adhering to guidelines had a higher percentage of having no brain abnormality detected. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 6 J. Magn. Reson. Imaging 2019;49:e250-e255.
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Affiliation(s)
- Min Yi Sum
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Kathy Low
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
| | - Phua Hwee Tang
- Department of Diagnostic & Interventional Imaging, KK Women's and Children's Hospital, Singapore
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Veerapandiyan A, Aravindhan A, Takahashi JH, Segal D, Pecor K, Ming X. Use of Head Computed Tomography (CT) in the Pediatric Emergency Department in Evaluation of Children With New-Onset Afebrile Seizure. J Child Neurol 2018; 33:708-712. [PMID: 29987971 DOI: 10.1177/0883073818786086] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Cranial computed tomography (CT) is not recommended in the routine evaluation of children with first afebrile seizure due to its low yield. The objective was to assess the current practice in our pediatric emergency department regarding the use of head CT in children with first afebrile seizure and to identify the factors that lead to ordering a head CT. METHODS Medical records of patients between 1 month and 18 years old evaluated at our emergency department for presentation of first afebrile seizure between 2010 and 2014 were retrospectively reviewed. Data extracted include age, gender, seizure type, single or multiple seizures at presentation, seizure duration, predisposing conditions to seizures (ie, history of developmental delay), and whether a head CT was performed. Contingency tables with chi-square analyses were used to determine which variables were associated with increased use of head CT. RESULTS Of 155 patients (88M/67F) included in the study, 72 (46.5%) underwent head CT and only 3 had clinically significant findings that did not require acute management. There were no differences in CT use by age, sex, seizure type, seizure number, seizure risk factors, or findings on physical examination. Head CT was performed more frequently in cases with seizures ≥5 minutes and unknown seizure duration ( P = .04). CONCLUSION Despite existing evidence, the emergent head CT rate was high in our cohort. Children with seizure duration of ≥5 minutes or of unknown duration were more likely to undergo head CT in our emergency department.
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Affiliation(s)
| | | | | | - Devorah Segal
- 4 Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Keith Pecor
- 5 Department of Biology, The College of New Jersey, Ewing, NJ, USA
| | - Xue Ming
- 3 Department of Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA
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15
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Challenges in managing epilepsy associated with focal cortical dysplasia in children. Epilepsy Res 2018; 145:1-17. [DOI: 10.1016/j.eplepsyres.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 04/30/2018] [Accepted: 05/12/2018] [Indexed: 12/15/2022]
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16
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Coryell J, Gaillard WD, Shellhaas RA, Grinspan ZM, Wirrell EC, Knupp KG, Wusthoff CJ, Keator C, Sullivan JE, Loddenkemper T, Patel A, Chu CJ, Massey S, Novotny EJ, Saneto RP, Berg AT. Neuroimaging of Early Life Epilepsy. Pediatrics 2018; 142:peds.2018-0672. [PMID: 30089657 PMCID: PMC6510984 DOI: 10.1542/peds.2018-0672] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We assessed the adherence to neuroimaging guidelines and the diagnostically relevant yield of neuroimaging in newly presenting early life epilepsy (ELE). METHODS There were 775 children with a new diagnosis of epilepsy (<3 years old at onset) who were recruited through the ELE study at 17 US pediatric epilepsy centers (2012-2015) and managed prospectively for 1 year. The data were analyzed to assess the proportion of children who underwent neuroimaging, the type of neuroimaging, and abnormalities. RESULTS Of 725 children (93.5%) with neuroimaging, 714 had an MRI (87% with seizure protocols) and 11 had computed tomography or ultrasound only. Etiologically relevant abnormalities were present in 290 individuals (40%) and included: an acquired injury in 97 (13.4%), malformations of cortical development in 56 (7.7%), and other diffuse disorders of brain development in 51 (7.0%). Neuroimaging was abnormal in 160 of 262 (61%) children with abnormal development at diagnosis versus 113 of 463 (24%) children with typical development. Neuroimaging abnormalities were most common in association with focal seizure semiology (40%), spasms (47%), or unclear semiology (42%). In children without spasms or focal semiology with typical development, 29 of 185 (16%) had imaging abnormalities. Pathogenic genetic variants were identified in 53 of 121 (44%) children with abnormal neuroimaging in whom genetic testing was performed. CONCLUSIONS Structural abnormalities occur commonly in ELE, and adherence to neuroimaging guidelines is high at US pediatric epilepsy centers. These data support the universal adoption of imaging guidelines because the yield is substantially high, even in the lowest risk group.
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Affiliation(s)
- Jason Coryell
- Departments of Pediatrics, Oregon Health and Sciences University, Portland, Oregon,Departments of Neurology, Oregon Health and Sciences University, Portland, Oregon
| | - William D. Gaillard
- Department of Neurology, Children’s National Health System and School of Medicine, The George Washington University, Washington, District of Columbia
| | | | - Zachary M. Grinspan
- Health Information Technology Evaluation Collaborative, Weill Cornell Medicine and New York–Presbyterian Hospital, New York, New York
| | | | - Kelly G. Knupp
- Department of Pediatrics and Neurology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Cynthia Keator
- Jane and John Justin Neurosciences Center, Cook Children’s Health Care System, Fort Worth, Texas
| | - Joseph E. Sullivan
- Department of Neurology, University of California, San Francisco, San Francisco, California
| | - Tobias Loddenkemper
- Division of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Anup Patel
- Department of Pediatrics, The Ohio State University and Nationwide Children’s Hospital, Columbus, Ohio
| | - Catherine J. Chu
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shavonne Massey
- Departments of Neurology, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Departments of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Edward J. Novotny
- Departments of Division of Pediatric Neurology, Neurology, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington,Departments of Pediatrics, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington,Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington
| | - Russel P. Saneto
- Departments of Division of Pediatric Neurology, Neurology, Seattle Children’s Research Institute, Seattle Children’s Hospital and University of Washington, Seattle, Washington
| | - Anne T. Berg
- Epilepsy Center, Ann and Robert H. Lurie Children’s Hospital of Chicago and Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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17
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Tsai MH, Chan CK, Chang YC, Lin CH, Liou CW, Chang WN, Ng CC, Lim KS, Hwang DY. Molecular Genetic Characterization of Patients With Focal Epilepsy Using a Customized Targeted Resequencing Gene Panel. Front Neurol 2018; 9:515. [PMID: 30034362 PMCID: PMC6043663 DOI: 10.3389/fneur.2018.00515] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/11/2018] [Indexed: 12/30/2022] Open
Abstract
Objective: Focal epilepsy is the most common subtype of epilepsies in which the influence of underlying genetic factors is emerging but remains largely uncharacterized. The purpose of this study is to determine the contribution of currently known disease-causing genes in a large cohort (n = 593) of common focal non-lesional epilepsy patients. Methods: The customized focal epilepsy gene panel (21 genes) was based on multiplex polymerase chain reaction (PCR) and sequenced by Illumina MiSeq platform. Results: Eleven variants (1.85%) were considered as pathogenic or likely pathogenic, including seven novel mutations. There were three SCN1A (p.Leu890Pro, p.Arg1636Ter, and p.Met1714Val), three PRRT2 (two p.Arg217Profs*8 and p.Leu298Pro), two CHRNA4 (p.Ser284Leu, p.Ile321Asn), one DEPDC5 (p.Val516Ter), one PCDH19 (p.Asp233Asn), and one SLC2A1 (p.Ser414Ter) variants. Additionally, 16 other rare variants were classified as unknown significance due to inconsistent phenotype or lack of segregation data. Conclusion: Currently known focal epilepsy genes only explained a very small subset of focal epilepsy patients. This indicates that the underlying genetic architecture of focal epilepsies is very heterogeneous and more novel genes are likely to be discovered. Our study highlights the usefulness, challenges and limitations of using the multi-gene panel as a diagnostic test in routine clinical practice in patients with focal epilepsy.
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Affiliation(s)
- Meng-Han Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chung-Kin Chan
- Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Ying-Chao Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Hsiang Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Chia-Wei Liou
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Wen-Neng Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung, Taiwan
| | - Ching-Ching Ng
- Genetics and Molecular Biology, Faculty of Science, Institute of Biological Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Kheng-Seang Lim
- Division of Neurology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Daw-Yang Hwang
- Division of Nephrology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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18
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Dirik MA, Sanlidag B. Magnetic Resonance Imaging and Interictal Electroencephalography Findings in Newly Diagnosed Epileptic Children. J Clin Med 2018; 7:E134. [PMID: 29865192 PMCID: PMC6025345 DOI: 10.3390/jcm7060134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Epilepsy is one of the most frequently diagnosed chronic neurological disorders in children. Diagnosis is often based on seizure history and electroencephalography (EEG) assessment. Magnetic resonance imaging (MRI) is recommended for etiologic workup and intervention requirements. We aimed to detect by MRI if focal structural abnormalities are present in the brain in relation to interictal epileptiform discharges (IED). MATERIAL AND METHODS The study was designed retrospectively. The data were collected from patients admitted to Near East University, Department of Pediatric Neurology, who were aged between 3 months and 18 years and who were diagnosed with epilepsy. The cases considered in the current study, however, were patients that had an EEG record prior to initiating treatment and an MRI within the first six months following diagnosis. RESULTS Among 222 patients, 212 (95.5%) had IED, and 92 (41.4%) had abnormal MRI results. The most frequently seen abnormalities detected by MRI were encephalomalacia, hydrocephaly, and atrophy. Among patients who had IED, the ones with multifocal IED were documented to have a statistically significant higher rate of abnormalities in MRI scans. In other patients, IED had no significant correlation with structural lesions detected by MRI. CONCLUSION IED can be unrelated to MRI findings. Focal IED were not statistically concordant with the structural lesions detected by MRI. However, for the cases with multifocal discharges revealed by interictal EEG, the rate of abnormalities detected using MRI was 68%. Therefore, the likelihood of detecting abnormalities using MRI in patients with multifocal IED does support the necessity of the use of MRI in early diagnosis stages.
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Affiliation(s)
- Mehmet Alp Dirik
- Faculty of Medicine, Department of Radioloy, Suat Gunsel University, Kyrenia 99138, North Cyprus.
| | - Burcin Sanlidag
- Faculty of Medicine, Department of Pediatrics Division of Pediatric Neurology, Near East University, Nicosia 99138, North Cyprus.
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19
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Sansevere AJ, Avalone J, Strauss LD, Patel AA, Pinto A, Ramachandran M, Fernandez IS, Bergin AM, Kimia A, Pearl PL, Loddenkemper T. Diagnostic and Therapeutic Management of a First Unprovoked Seizure in Children and Adolescents With a Focus on the Revised Diagnostic Criteria for Epilepsy. J Child Neurol 2017; 32:774-788. [PMID: 28503985 DOI: 10.1177/0883073817706028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
By definition, unprovoked seizures are not precipitated by an identifiable factor, such as fever or trauma. A thorough history and physical examination are essential to caring for pediatric patients with a potential first unprovoked seizure. Differential diagnosis, EEG, neuroimaging, laboratory tests, and initiation of treatment will be reviewed. Treatment is typically initiated after 2 unprovoked seizures, or after 1 seizure in select patients with distinct epilepsy syndromes. Recent expansion of the definition of epilepsy by the ILAE allows for the diagnosis of epilepsy to be made after the first seizure if the clinical presentation and supporting diagnostic studies suggest a greater than 60% chance of a second seizure. This review summarizes the current literature on the diagnostic and therapeutic management of first unprovoked seizure in children and adolescents while taking into consideration the revised diagnostic criteria of epilepsy.
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Affiliation(s)
- Arnold J Sansevere
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer Avalone
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Lauren Doyle Strauss
- 2 Department of Neurology, Wake Forest Baptist Health, Wake Forest Medical School, Winston Salem, NC, USA
| | - Archana A Patel
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anna Pinto
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Ann M Bergin
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amir Kimia
- 4 Department of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Phillip L Pearl
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Loddenkemper
- 1 Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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20
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Jeon TY, Kim JH, Lee J, Yoo SY, Hwang SM, Lee M. Value of Repeat Brain MRI in Children with Focal Epilepsy and Negative Findings on Initial MRI. Korean J Radiol 2017; 18:729-738. [PMID: 28670168 PMCID: PMC5447649 DOI: 10.3348/kjr.2017.18.4.729] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/26/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the value of repeat brain magnetic resonance imaging (MRI) in identifying potential epileptogenic lesions in children with initial MRI-negative focal epilepsy. Materials and Methods Our Institutional Review Board approved this retrospective study and waived the requirement for informed consent. During a 15-year period, 257 children (148 boys and 109 girls) with initial MRI-negative focal epilepsy were included. After re-evaluating both initial and repeat MRIs, positive results at repeat MRI were classified into potential epileptogenic lesions (malformation of cortical development and hippocampal sclerosis) and other abnormalities. Contributing factors for improved lesion conspicuity of the initially overlooked potential epileptogenic lesions were analyzed and classified into lesion factors and imaging factors. Results Repeat MRI was positive in 21% (55/257) and negative in 79% cases (202/257). Of the positive results, potential epileptogenic lesions comprised 49% (27/55) and other abnormalities comprised 11% of the cases (28/257). Potential epileptogenic lesions included focal cortical dysplasia (n = 11), hippocampal sclerosis (n = 10), polymicrogyria (n = 2), heterotopic gray matter (n = 2), microlissencephaly (n = 1), and cortical tumor (n = 1). Of these, seven patients underwent surgical resection. Contributing factors for new diagnoses were classified as imaging factors alone (n = 6), lesion factors alone (n = 2), both (n = 18), and neither (n = 1). Conclusion Repeat MRI revealed positive results in 21% of the children with initial MRI-negative focal epilepsy, with 50% of the positive results considered as potential epileptogenic lesions. Enhanced MRI techniques or considering the chronological changes of lesions on MRI may improve the diagnostic yield for identification of potential epileptogenic lesions on repeat MRI.
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Affiliation(s)
- Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jeehun Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - So-Young Yoo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sook Min Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Munhyang Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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21
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Rincon SP, Blitstein MBK, Caruso PA, González RG, Thibert RL, Ratai EM. The Use of Magnetic Resonance Spectroscopy in the Evaluation of Pediatric Patients With Seizures. Pediatr Neurol 2016; 58:57-66. [PMID: 26948493 DOI: 10.1016/j.pediatrneurol.2016.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 01/09/2016] [Accepted: 01/11/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective was to determine if it is useful to routinely add magnetic resonance spectroscopy (MRS) to magnetic resonance imaging (MRI) in the evaluation of seizure in the pediatric patient. Specifically, how often does MRS contribute information to conventional MRI? METHODS A retrospective search, over a period of 3 years, of patients <18 years of age who underwent both MRI and MRS as part of the evaluation of seizures yielded a total of 233 cases in 216 patients. The medical records were reviewed to determine how many patients carried a diagnosis relevant to seizures. The MRIs and MRSs were reviewed by two neuroradiologists and an MR physicist/spectroscopist who determined by consensus in how many cases MRS contributed information regarding management, diagnosis, or prognosis, in addition to the findings on MRI alone. RESULTS In 100 of 233 cases (43%), MRS contributed information additional to MRI. In 40 cases, MRS contributed information relevant to patient management by prompting an evaluation for an underlying inborn error of metabolism. MRS contributed information relevant to diagnosis in 24 of 100 cases (e.g., neoplasm versus dysplasia). MRS contributed information relevant to prognosis in 36 cases (e.g., hypoxic-ischemic injury). MRS added more information in cases where the patients had a diagnosis relevant to seizure before imaging. Interestingly, in 25 cases where the MRI was normal, MRS was found to be abnormal, which prompted evaluation for an inborn error of metabolism. CONCLUSIONS These results suggest that MRS is a useful evaluation tool in addition to MRI for children undergoing imaging for the evaluation of seizures.
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Affiliation(s)
- Sandra P Rincon
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Marisa B K Blitstein
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul A Caruso
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - R Gilberto González
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ronald L Thibert
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Eva-Maria Ratai
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
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Abstract
Pediatric neurology relies on ultrasound, computed tomography (CT), and magnetic resonance (MR) imaging. CT prevails in acute neurologic presentations, including traumatic brain injury (TBI), nontraumatic coma, stroke, and status epilepticus, because of easy availability, with images of diagnostic quality, e.g., to exclude hemorrhage, usually completed quickly enough to avoid sedation. Concerns over the risks of ionizing radiation mean re-imaging and higher-dose procedures, e.g., arteriography and venography, require justification. T1/T2-weighted imaging (T1/T2-WI) MR with additional sequences (arteriography, venography, T2*, spectroscopy, diffusion tensor, perfusion, diffusion- (DWI) and susceptibility-weighted imaging (SWI)) often clarifies the diagnosis, which may alter management in acute settings, as well as chronic conditions, e.g., epilepsy. Clinical acumen remains essential to avoid imaging, e.g., in genetic epilepsies or migrainous headaches responding to treatment, or to target sequences to specific diagnosis, e.g., T1/T2-WI for shunt dysfunction (with SWI for TBI); DWI, arteriography including neck vessels, and venography for acute hemiplegia or coma; coronal temporal cuts for partial epilepsy; or muscle imaging for motor delay. The risk of general anesthesia is low; "head-only" scanners may allow rapid MRI without sedation. Timely and accurate reporting, with discrepancy discussion between expert neuroradiologists, is important for management of the child and the family's expectations.
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Sanmaneechai O, Danchaivijitr N, Likasitwattanakul S. Predictors of Abnormal Neuroimaging of the Brain in Children With Epilepsy Aged 1 Month to 2 Years: Useful Clues in a Resource-Limited Setting. J Child Neurol 2015; 30:1532-6. [PMID: 25792429 DOI: 10.1177/0883073815574199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 01/12/2015] [Indexed: 11/15/2022]
Abstract
Neuroimaging should be performed on infants with seizure. However, there are economic limitations in performing neuroimaging in a resource-limited setting. The younger the age, the higher the risk of having abnormal neuroimaging. The aim was to determine frequency and predictors of abnormal neuroimaging in children with epilepsy aged 1 month to 2 years. History, physical examination, electroencephalogram (EEG), and neuroimaging were reviewed. Thirty-seven of 49 (76%) had neuroimaging studies; 19 computed tomography (CT), 14 magnetic resonance imaging (MRI), and 4 had both. Abnormal neuroimaging was found in 19 (51%). Predictors of abnormal neuroimages are developmental delay, abnormal head circumference, and abnormal neurologic examination. Eight children (21%) had lesions on neuroimaging studies that altered or influenced management. Of 8 patients with normal examination and EEG, 1 had a brain tumor and another had arteriovenous malformation. Neuroimaging should be considered as an essential aid in the evaluation of infants with epilepsy, even in a resource-limited setting.
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Affiliation(s)
- Oranee Sanmaneechai
- Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nasuda Danchaivijitr
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Dayan PS, Lillis K, Bennett J, Conners G, Bailey P, Callahan J, Akman C, Feldstein N, Kriger J, Hauser WA, Kuppermann N. Prevalence of and Risk Factors for Intracranial Abnormalities in Unprovoked Seizures. Pediatrics 2015. [PMID: 26195538 PMCID: PMC4516940 DOI: 10.1542/peds.2014-3550] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Prospective data are lacking to determine which children might benefit from prompt neuroimaging after unprovoked seizures. We aimed to determine the prevalence of, and risk factors for, relevant intracranial abnormalities in children with first, unprovoked seizures. METHODS We conducted a 6-center prospective study in children aged >28 days to 18 years with seemingly unprovoked seizures. Emergency department (ED) clinicians documented clinical findings on a standardized form. Our main outcome was the presence of a clinically relevant intracranial abnormality on computed tomography (CT) or MRI, defined as those that might change management, either emergently, urgently, or nonurgently. RESULTS We enrolled 475 of 625 (76%) eligible patients. Of 354 patients for whom cranial MRI or CT scans were obtained in the ED or within 4 months of the ED visit, 40 (11.3%; 95% confidence interval [CI]: 8.0-14.6%) had clinically relevant intracranial abnormalities, with 3 (0.8%; 95% CI: 0.1-1.8%) having emergent/urgent abnormalities. On logistic regression analysis, a high-risk past medical history (adjusted odds ratio: 9.2; 95% CI: 2.4-35.7) and any focal aspect to the seizure (odds ratio: 2.5; 95% CI: 1.2-5.3) were independently associated with clinically relevant abnormalities. CONCLUSIONS Clinically relevant intracranial abnormalities occur in 11% of children with first, unprovoked seizures. Emergent/urgent abnormalities, however, occur in <1%, suggesting that most children do not require neuroimaging in the ED. Findings on patient history and physical examination identify patients at higher risk of relevant abnormalities.
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Affiliation(s)
- Peter S. Dayan
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Kathleen Lillis
- Department of Pediatrics, State University of New York at Buffalo, Buffalo, New York
| | - Jonathan Bennett
- Department of Pediatrics, Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Gregory Conners
- Department of Emergency Medicine, University of Rochester, Rochester, New York
| | - Pam Bailey
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - James Callahan
- Departments of Emergency Medicine and Pediatrics, Upstate Medical College, Syracuse, New York
| | - Cigdem Akman
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Neil Feldstein
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Joshua Kriger
- Department of Biostatistics, Columbia University Medical Center, New York, New York
| | - W. Allen Hauser
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York;,Gertrude Sergievsky Center, New York, New York; and
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, Davis School of Medicine, University of California, Sacramento, California
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Sugano H, Arai H. Epilepsy surgery for pediatric epilepsy: optimal timing of surgical intervention. Neurol Med Chir (Tokyo) 2015; 55:399-406. [PMID: 25925754 PMCID: PMC4628167 DOI: 10.2176/nmc.ra.2014-0369] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pediatric epilepsy has a wide variety of etiology and severity. A recent epidemiological study suggested that surgery might be indicated in as many as 5% of the pediatric epilepsy population. Now, we know that effective epilepsy surgery can result in seizure freedom and improvement of psychomotor development. Seizure control is the most effective way to improve patients neurologically and psychologically. In this review, we look over the recent evidence related to pediatric epilepsy surgery, and try to establish the optimal surgical timing for patients with intractable epilepsy. Appropriate surgical timing depends on the etiology and natural history of the epilepsy to be treated. The most common etiology of pediatric intractable epilepsy patients is malformation of cortical development (MCD) and early surgery is recommended for them. Patients operated on earlier than 12 months of age tended to improve their psychomotor development compared to those operated on later. Recent progress in neuroimaging and electrophysiological studies provide the possibility of very early diagnosis and comprehensive surgical management even at an age before 12 months. Epilepsy surgery is the only solution for patients with MCD or other congenital diseases associated with intractable epilepsy, therefore physicians should aim at an early and precise diagnosis and predicting the future damage, consider a surgical solution within an optimal timing.
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Yoong M. Quantifying the deficit-imaging neurobehavioural impairment in childhood epilepsy. Quant Imaging Med Surg 2015; 5:225-37. [PMID: 25853081 DOI: 10.3978/j.issn.2223-4292.2015.01.06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/14/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neurobehavioral impairments such as learning difficulty, autism, attention deficit hyperactivity disorder (ADHD) and mood or behavioural problems are known to be increased in children with epilepsy; however, they remain under-recognised and often cause considerable morbidity. Quantitative neuroimaging techniques offer a potential avenue to improving our understanding of the underlying pathological basis for these disorders, aiding with diagnosis and risk stratification. METHODS A systematic review was undertaken for original research articles involving magnetic resonance imaging in children with epilepsy and one or more neurobehavioural impairments. Studies were reviewed with respect to patient population, methodology and magnetic resonance imaging (MRI) findings. RESULTS A total of 25 studies were identified and included in this review. The majority of studies looked at single impairments, commonly cognitive impairment or ADHD, with few studies reporting on other impairments. Reductions in cortical grey matter and disruptions of functional and structural brain networks were associated with poorer cognitive performance and disruptions of grey and white matter within a fronto-striatal-cerebellar network associated with ADHD. Insufficient studies were available to report on other impairments. CONCLUSIONS Relatively few studies exist in this field and those that do are methodologically diverse. Further investigation is required to determine if the changes reported to date are epilepsy syndrome specific or have broader applicability.
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Affiliation(s)
- Michael Yoong
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, UK
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Abstract
PURPOSE OF REVIEW Status epilepticus is an acute neurologic emergency, the incidence of which is increasing in the United States as the definition evolves and our detection abilities improve. We will present the current definition of status epilepticus, including a recently modified operational definition for use in the clinical setting. We will also provide updates on identifying children in status epilepticus, etiologic considerations, and the rationale for diagnostic testing. RECENT FINDINGS Recent data reveal the benefits of MRI vs. computed tomography in new-onset status epilepticus, as well as high rates of identification of electrographic seizures in patients with unexplained acute encephalopathy in pediatric ICU settings. Genetic testing should be considered in young children with recurrent status epilepticus. SUMMARY Prompt recognition and diagnostic evaluation of the child in status epilepticus will help identify causes, which may require specific treatment, and help in the management of this life-threatening condition. Laboratory work, neuroimaging, electroencephalogram or continuous video electroencephalogram, lumbar puncture, and genetic testing may be considered in the evaluation of the child in status epilepticus.
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Babtain FA. Impact of a family history of epilepsy on the diagnosis of epilepsy in southern Saudi Arabia. Seizure 2013; 22:542-7. [DOI: 10.1016/j.seizure.2013.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 04/02/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022] Open
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Structural brain imaging. HANDBOOK OF CLINICAL NEUROLOGY 2012. [PMID: 22938982 DOI: 10.1016/b978-0-444-52898-8.00022-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register]
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Craven IJ, Griffiths PD, Bhattacharyya D, Grunewald RA, Hodgson T, Connolly DJA, Coley SC, Batty R, Romanowski CAJ, Hoggard N. 3.0 T MRI of 2000 consecutive patients with localisation-related epilepsy. Br J Radiol 2012; 85:1236-42. [PMID: 22573303 DOI: 10.1259/bjr/30177037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Clinical guidelines suggest that all patients diagnosed with localised seizures should be investigated with MRI to identify any epileptogenic structural lesions, as these patients may benefit from surgical resection. There is growing impetus to use higher field strength scanners to image such patients, as some evidence suggests that they improve detection rates. We set out to review the detection rate of radiological abnormalities found by imaging patients with localised seizures using a high-resolution 3.0 T epilepsy protocol. METHODS Data were reviewed from 2000 consecutive adult patients with localisation-related epilepsy referred between January 2005 and February 2011, and imaged at 3.0 T using a standard epilepsy protocol. RESULTS An abnormality likely to be related to seizure activity was identified in 403/2000 (20.2%) patients, with mesial temporal sclerosis diagnosed in 211 patients. 313/2000 (15.6%) had lesions potentially amenable to surgery. Abnormalities thought unrelated to seizure activity were found in 324/2000 (16.1%), with 8.9% having evidence of ischaemic disease. CONCLUSIONS Since the introduction of the then National Institute for Clinical Excellence guidelines in 2004, the detection rate of significant pathology using a dedicated 3.0 T epilepsy protocol has not fallen, despite the increased numbers of patients being imaged. This is the largest study of epilepsy imaging at 3.0 T to date and highlights the detection rates of significant pathology in a clinical setting using a high-strength magnet. The prevalence of ischaemic disease in this population is significantly higher than first thought, and may not be incidental, as is often reported.
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Affiliation(s)
- I J Craven
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK.
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Honing in on Risk Factors for Prolonged Remission off Medication by Reducing Heterogeneity. Epilepsy Curr 2012; 12:95-6. [DOI: 10.5698/1535-7511-12.3.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Trichard M, Léautaud A, Bednarek N, Mac-Caby G, Cardini-Poirier S, Motte J, Hoeffel C. [Neuroimaging in pediatric epilepsy]. Arch Pediatr 2012; 19:509-22. [PMID: 22480465 DOI: 10.1016/j.arcped.2012.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 11/15/2011] [Accepted: 02/24/2012] [Indexed: 12/18/2022]
Abstract
The main causes of epilepsy in children are cortical malformations (hemimegalencephaly, cortical dysplasia, lissencephaly, etc.) and phakomatosis (tuberous sclerosis, Sturge-Weber disease, neurofibromatosis type 1, etc.), perinatal ischemia, traumatisms, infections, mesial temporal sclerosis, metabolic diseases, and tumors. Imaging indications are precise, including partial seizures and a pathological electroencephalogram. Twenty-five percent of these epilepsy cases are pharmacoresistant. Indeed, MRI is essential to consider surgical treatment, allowing one to localize potential epileptogenic anatomic lesions. The protocol includes sequences in three planes of space, weighted in T1, T2, Flair, T1 inversion-recovery, and T1 after gadolinium injection. MRI findings are characteristic for some tumors, but most malformations are subtle. Consequently recent techniques (spectroscopy, diffusion, etc.) are crucial when conventional MRI is not sufficient. The aim of this article is to illustrate, with a substantive image revue, this wide diversity of etiologies in pediatric epilepsy, in order to help the attendee recognize MRI findings, also discussing the role of newer imaging modalities in this field.
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Affiliation(s)
- M Trichard
- Service de pédiatrie A, pôle Mère-Enfant, CHU de Reims, 47, rue Cognacq-Jay, 51092 Reims cedex, France.
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Yoong M, Madari R, Martinos M, Clark C, Chong K, Neville B, Chin R, Scott R. The role of magnetic resonance imaging in the follow-up of children with convulsive status epilepticus. Dev Med Child Neurol 2012; 54:328-33. [PMID: 22268666 DOI: 10.1111/j.1469-8749.2011.04215.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to determine the yield of magnetic resonance imaging (MRI) after an episode of childhood convulsive status epilepticus (CSE) and to identify the clinical predictors of an abnormal brain scan. METHOD Children were recruited following an episode of CSE from an established clinical network in north London. Eighty children (age range 1mo-16y; 39 males; 41 females) were enrolled and seen for clinical assessment and brain MRI within 13 weeks of suffering from an episode of CSE. Scans were reviewed by two neuroradiologists and classified as normal (normal/normal-variant) or abnormal (minor/major abnormality). Factors predictive of an abnormal scan were investigated using logistic regression. RESULTS Eighty children were recruited at a mean of 31.8 days (5-90d) after suffering from CSE. Structural abnormalities were found in 31%. Abnormal neurological examination at assessment (odds ratio [OR] 190.46), CSE that was not a prolonged febrile seizure (OR 77.12), and a continuous rather than an intermittent seizure (OR 29.98) were all predictive of an abnormal scan. No children with previous neuroimaging had new findings that altered their clinical management. INTERPRETATION Brain MRI should be considered for all children with a history of CSE who have not previously undergone MRI, especially those with non-prolonged febrile seizure CSE, those with persisting neurological abnormalities 2 to 13 weeks after CSE, and those with continuous CSE.
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Burton KJ, Rogathe J, Whittaker R, Mankad K, Hunter E, Burton MJ, Todd J, Neville BGR, Walker R, Newton CRJC. Epilepsy in Tanzanian children: association with perinatal events and other risk factors. Epilepsia 2012; 53:752-60. [PMID: 22308971 PMCID: PMC3467761 DOI: 10.1111/j.1528-1167.2011.03395.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Purpose To define the prevalence and risk factors for epilepsy in children in a rural district of Tanzania by conducting a community-based case–control study. Methods Children aged 6–14 years with active epilepsy (at least two unprovoked seizures in the last 5 years) were identified in a cross-sectional survey in Tanzania. Cases were compared with age-matched controls. Key Findings Overall 112 children with epilepsy (CWE) were identified; the unadjusted prevalence of epilepsy was 2.91 per 1,000 (95% confidence interval [95% CI] 2.4–3.5). The main seizure types were focal motor with secondary generalization in 73 (65.2%) of 112 and generalized convulsive seizures in 19 (16.9%) of 112. Adverse perinatal events were present in 16 (14%) of 112 cases but in no controls. In multivariate analysis, epilepsy was associated with number of parents who were resident at home (odds ratio [OR] 6.2 for none vs. both resident, 95% CI 1.5–25.5), history of adverse perinatal events (OR 14.9, 95% CI 1.4–151.3), family history of afebrile seizures (OR 5.7, 95% CI 1.0–27.5), and poor scholastic attainment (OR 8.6, 95% CI 4.0–18.4). Electroencephalography (EEG) and computed tomography (CT) scans were abnormal in 44 (44%) of 101 and 26 (29%) of 90 cases, respectively. Overall, 98 (88%) of 112 cases had focal features on assessment. Significance In this study from sub-Saharan Africa, CWE predominantly had focal features that support the suggestion that most epilepsy in this region has a symptomatic etiology. Adverse perinatal events were strongly associated with epilepsy. Genetic and social factors may also be important. Epilepsy may be preventable in a significant proportion of children with better antenatal and perinatal care.
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Durá-Travé T, Yoldi-Petri ME, Esparza-Estaún J, Gallinas-Victoriano F, Aguilera-Albesa S, Sagastibelza-Zabaleta A. Magnetic resonance imaging abnormalities in children with epilepsy. Eur J Neurol 2012; 19:1053-9. [PMID: 22248328 DOI: 10.1111/j.1468-1331.2011.03640.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study is to analyze the proportional distribution of epilepsy and epileptic syndromes in children and to describe the magnetic resonance imaging (MRI) abnormalities found in these patients. METHODS Data from 457 children aged 1 month to 15 years at the time of diagnosis of epilepsy were recorded. A routine MRI has been requested in all patients with epilepsy at diagnosis according to a standardized pediatric seizure protocol. Abnormalities on MRI were classified as either significant or non-significant (standardized scoring system). International League Against Epilepsy criteria were used for diagnoses. RESULTS The prevalence of significant MRI abnormalities was 21.9% (in infants 42.3%, in childhood 18.2%, and in adolescents 15.9%). The most common abnormalities included white-matter lesions (27.6%), volume loss (19.6%), gray-matter lesions (19.6%), and ventricular enlargement (12%). CONCLUSIONS The use of MRI and a reliable standardized scoring system at diagnosis of epilepsy in children identified a high rate of significant abnormalities findings. This may have important implications for practice guidelines in this population.
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Affiliation(s)
- T Durá-Travé
- Neurology Pediatric Unit, Navarra Hospital Complex, Pamplona Department of Neuroradiology, Navarra Hospital Complex, Pamplona, Spain.
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Rasool A, Choh SA, Wani NA, Ahmad SM, Iqbal Q. Role of electroencephalogram and neuroimaging in first onset afebrile and complex febrile seizures in children from Kashmir. J Pediatr Neurosci 2012; 7:9-15. [PMID: 22837769 PMCID: PMC3401669 DOI: 10.4103/1817-1745.97611] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES (1) To determine the frequency of abnormal neuroimaging in children with new-onset afebrile and complex febrile seizures; (2) to draw a correlation between Electroencephalogram (EEG) and neuroimaging. STUDY DESIGN A hospital-based prospective study. MATERIALS AND METHODS A total of 276 children (6 months to 14 years of age), who presented with new-onset afebrile or complex febrile seizures, underwent EEG and neuroimaging [Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI)]. RESULTS Generalized seizures constituted the major seizure group in our study - 116/276 (42%) - followed by partial seizures 86/276 (31.2%) and complex febrile seizure in 64/276 (23.2%). Generalized as well as partial seizures were more common in children aged 6-14 years, while complex febrile seizures were predominantly seen in children less than 6 years old. Most of the patients with generalized and partial seizures had EEG abnormalities, while EEG abnormalities were uncommon in patients with complex febrile seizures. A total of 27/276 (9.8%) patients with seizure disorder had abnormal CT scans and this abnormality was more common in patients with partial seizures. CT abnormality was seen more commonly in those patients who had an abnormal EEG. EEG and CT correlation showed that patients with abnormal EEG had higher rates of CT abnormality, ie, 16.1% (25/155). Abnormal MRI was seen in 32/157 (20.4%) of patients; accuracy of picking abnormality by MRI, when EEG was abnormal, was 24.8% (P<0.05). CONCLUSION Our findings indicate that clinical examination and EEG results are good indicators for neuroimaging, and these can be used as one of the criteria for ordering neuroimaging in new-onset seizures.
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Affiliation(s)
- Akhter Rasool
- Department of Pediatrics, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
| | - Suhil A. Choh
- Department of Pediatrics, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
| | - Nisar A. Wani
- Department of Radiology, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
| | - S. Mushtaq Ahmad
- Department of Pediatrics, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
| | - Qazi Iqbal
- Department of Pediatrics, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Kashmir, India
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Baca CB, Vickrey BG, Caplan R, Vassar SD, Berg AT. Psychiatric and medical comorbidity and quality of life outcomes in childhood-onset epilepsy. Pediatrics 2011; 128:e1532-43. [PMID: 22123895 PMCID: PMC3387901 DOI: 10.1542/peds.2011-0245] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We compared associations of epilepsy remission status and severity as well as psychiatric and other comorbidities with child and parent-proxy reports of health-related quality of life (HRQoL) in adolescents previously diagnosed with epilepsy. METHODS In a prospective, community-based study of newly diagnosed childhood epilepsy, HRQoL of 277 children was assessed 8 to 9 years after diagnosis by using child and parent-proxy versions of the Child Health Questionnaire (CHQ). Multiple linear regression models adjusted for age and gender were used to compare associations of epilepsy remission and "complicated" epilepsy (secondary to an underlying neurologic insult or epileptic encephalopathy) status and psychiatric and other comorbidities with HRQoL. RESULTS Mean age of epilepsy onset was 4.4 years (SD: 2.6). At the 9-year reassessment, children were, on average, 13.0 years old (SD: 2.6); 64% were seizure-free for 5 years, 31% were taking antiepileptic drugs, and 19% had a complicated epilepsy. Prevalence of comorbidities at follow-up were 26% psychiatric diagnosis; 39% neurodevelopmental spectrum disorder (NDSD); 24% chronic medical illness; and 15% migraine. In multivariable analysis, having a psychiatric disorder was broadly associated with child (6 of 11 scales) and parent-proxy (7 of 12 scales) HRQoL (P ≤ .0125). Five-year remission and complicated epilepsy status had few or no associations with HRQoL. Although parent-proxy HRQoL was strongly associated with NDSD (6 of 11 scales), child-reported HRQoL was not (2 of 11 scales). CONCLUSIONS Psychiatric comorbidities are strongly associated with long-term HRQoL in childhood-onset epilepsy, which suggests that comprehensive epilepsy care must include screening and treatment for these conditions, even if seizures remit.
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Affiliation(s)
- Christine B. Baca
- Departments of Neurology and ,VA Greater Los Angeles Healthcare System, Los Angeles, California; and
| | - Barbara G. Vickrey
- Departments of Neurology and ,VA Greater Los Angeles Healthcare System, Los Angeles, California; and
| | - Rochelle Caplan
- Psychiatry, University of California Los Angeles, Los Angeles, California
| | - Stefanie D. Vassar
- Departments of Neurology and ,VA Greater Los Angeles Healthcare System, Los Angeles, California; and
| | - Anne T. Berg
- Northwestern Children's Hospital, Chicago, Illinois
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Berg AT, Testa FM, Levy SR. Complete remission in nonsyndromic childhood-onset epilepsy. Ann Neurol 2011; 70:566-73. [PMID: 21710620 PMCID: PMC3183287 DOI: 10.1002/ana.22461] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 04/10/2011] [Accepted: 04/22/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Determine the probability of attaining complete remission in children with nonsyndromic epilepsy (NSE) over the course of ≥10 years from initial diagnosis; identify early predictors of complete remission; and assess the risk of relapse after achieving complete remission. METHODS In a prospective community-based cohort, complete remission was defined as 5 years seizure-free and medication-free. Any subsequent seizure for any reason was a relapse. Univariate and bivariate analyses were conducted with standard methods including the Kaplan-Meier approach. Proportional hazards modeling was used for multivariable analysis. RESULTS Of 613 cohort members, 347 had NSEs, of whom 294 (85%) were followed ≥10 years (maximum = 17.9). A total of 170 in 294 (58%) achieved complete remission, 10 of whom (6%) relapsed. Seizure outcome at 2 years (remission, pharmacoresistant, unclear) (p < 0.0001) and underlying cause (p < 0.0001) distinguished groups with complete remission ranging from ~20% to ~75%. Older age at onset was independently associated with a poorer chance of complete remission. Relapses occurred up to 7.5 years after attaining complete remission and were marginally associated with underlying cause (p = 0.06). INTERPRETATION Complete remission occurs in over one-half of young people with NSE and generally persists. Meaningful but imperfect predication is possible based on underlying cause and early seizure control. The finding of age effects may play a role in meaningful identification of phenotypes, which could become fruitful targets for genetic and imaging investigations in these otherwise poorly differentiated epilepsies.
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Affiliation(s)
- Anne T Berg
- Epilepsy Center, Children's Memorial Hospital, Northwestern University, Chicago, IL, USA.
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Berg AT, Pardoe HR, Fulbright RK, Schuele SU, Jackson GD. Hippocampal size anomalies in a community-based cohort with childhood-onset epilepsy. Neurology 2011; 76:1415-21. [PMID: 21502602 DOI: 10.1212/wnl.0b013e318216712b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Epidemiologic evidence suggests the natural history of refractory mesial temporal lobe epilepsy is complicated, yet little is known about the hippocampus from the nontertiary center perspective. METHODS In a community-based cohort, individuals with nonsyndromic focal epilepsy with onset <16 years and controls had research MRI scans. Hippocampal (HC) volumes were manually measured, corrected for total brain volume, and converted to Z scores (Z(HC)) based on the controls' values. Volumes in cases and controls were compared. RESULTS Average volumes were not significantly different in cases with unknown cause (n = 117) relative to controls (n = 63). The group with structural and other conditions (n = 23) had significantly smaller volumes. Asymmetry (larger/smaller HC) did not vary among the 3 groups. Hippocampal variances were significantly larger in each epilepsy group relative to controls. In the unknown cause group, 25 (21%) had extreme() values: 15 (13%) with Z(HC) >1.96; 10 (9%) with Z(HC) <-1.96. By contrast, 2/63 (3%) controls had extreme values (p = 0.001). Within the unknown cause group, temporal lobe epilepsy (TLE) cases were more likely to have extreme hippocampal volumes than non-TLE (31% vs 15%, p = 0.03). Extreme volumes were generally interpreted as normal visually. These anomalies were not associated with seizure remission or pharmacoresistance. CONCLUSIONS Classic mesial TLE with hippocampal sclerosis is an uncommon finding in the general population. Volume anomalies, both large and small, are often bilateral. The significance of these findings is unclear; however, speculations regarding preexisting hippocampal pathology (e.g., dysplasia) as a factor in TLE and other neocortical epilepsies have been made by others.
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Affiliation(s)
- A T Berg
- Department of Biology, Northern Illinois University, DeKalb, IL 60115, USA.
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Abstract
Status epilepticus (SE) is an acute neurologic emergency that requires prompt recognition and initiation of treatment. Recognition can be difficult because SE comes in many forms and has been defined differently over the past decade. We present the general consensus definition of SE and how to use the definition, including a modified operational definition, to guide management. Furthermore, evaluation of the child who presents in SE is important to determine the etiology and identify underlying causes that may require additional treatment. Evaluation may include measurement of electrolytes, lumbar puncture, drug levels, electroencephalography, and/or neuroimaging. Recent data are presented that update the current practice parameter guidelines and also indicate that neuroimaging is important in cases of new-onset SE and can help significantly in the diagnosis and management.
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Hsieh DT, Chang T, Tsuchida TN, Vezina LG, Vanderver A, Siedel J, Brown K, Berl MM, Stephens S, Zeitchick A, Gaillard WD. New-onset afebrile seizures in infants: role of neuroimaging. Neurology 2010; 74:150-6. [PMID: 20065250 DOI: 10.1212/wnl.0b013e3181c91847] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the presenting characteristics of new-onset afebrile seizures in infants (age 1-24 months) and the yield of neuroimaging. METHODS Prospective data were obtained from a standardized evaluation and management plan mandated by a critical care pathway. A total of 317 infants presented with new-onset afebrile seizures between 2001 and 2007. EEG was performed on 90.3%, head CT was obtained on 94%, and MRI was obtained on 57.4%. RESULTS We found half of the infants had partial features to their seizures, yet evidence for primary generalized seizures was rare. The majority had more than 1 seizure upon presentation. Seizures in this age group tended to be brief, with 44% lasting less than 1 minute. EEG abnormalities were found in half. One-third of CTs were abnormal, with 9% of all CTs requiring acute medical management. Over half of MRIs were abnormal, with cerebral dysgenesis being the most common abnormality (p < 0.05). One-third of normal CTs had a subsequent abnormal MRI-only 1 resulted in altered medical management. CONCLUSIONS Infantile seizures are usually brief, but commonly recurrent, and strong consideration should be made for inpatient observation. Acute imaging with CT can alter management in a small but important number of infants. Due to the superior yield, strong consideration for MRI should be given for all infants, as primary generalized seizures are rare, and there is a high rate of cerebral dysgenesis.
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Affiliation(s)
- D T Hsieh
- Center for Neuroscience, Children's National Medical Center, Washington, DC 20010, USA
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Singh RK, Stephens S, Berl MM, Chang T, Brown K, Vezina LG, Gaillard WD. Prospective study of new-onset seizures presenting as status epilepticus in childhood. Neurology 2010; 74:636-42. [PMID: 20089940 DOI: 10.1212/wnl.0b013e3181d0cca2] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize children with new-onset seizures presenting as status epilepticus at a tertiary care children's hospital. METHODS Prospectively collected data were reviewed from a database derived from a mandated critical care pathway. A total of 1,382 patients presented with new-onset seizures between 2001 and 2007. RESULTS A total of 144 patients presented in status epilepticus. The average age was 3.4 years. The majority of seizures (72%) lasted between 21 and 60 minutes. The majority of patients had no significant past medical history; one-fourth had a family history of epilepsy. Five (4%) patients with EEGs had electrographic seizures during the study, captured only with prolonged monitoring. The most common etiology was febrile convulsion, followed by cryptogenic. The most common acute symptomatic cause was CNS infection; the most common remote symptomatic cause was cerebral dysgenesis. Combined CT and MRI provided a diagnosis in 30%. CT was helpful in identifying acute vascular lesions and acute edema, whereas MRI was superior in identifying subtle abnormalities and remote symptomatic etiologies such as dysplasia and mesial temporal sclerosis. CONCLUSIONS Children who present in status epilepticus that is not a prolonged febrile convulsion should undergo neuroimaging in the initial evaluation. For any child who presents in status epilepticus and has not yet returned to baseline, the possibility of nonconvulsive status epilepticus should be considered. Although CT is often more widely accepted, especially in the urgent setting, strong consideration for MRI should be given when available, due to the superior yield.
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Affiliation(s)
- R K Singh
- Department of Neuroscience, Children's National Medical Center, Washington, DC 20010, USA
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Berg AT, Mathern GW, Bronen RA, Fulbright RK, DiMario F, Testa FM, Levy SR. Frequency, prognosis and surgical treatment of structural abnormalities seen with magnetic resonance imaging in childhood epilepsy. Brain 2009; 132:2785-97. [PMID: 19638447 DOI: 10.1093/brain/awp187] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The epidemiology of lesions identified by magnetic resonance imaging (MRI), along with the use of pre-surgical evaluations and surgery in childhood-onset epilepsy patients has not previously been described. In a prospectively identified community-based cohort of children enrolled from 1993 to 1997, we examined (i) the frequency of lesions identified by MRI; (ii) clinical factors associated with 'positive' MRI scans; and (iii) the utilization of comprehensive epilepsy evaluations and neurosurgery. Of the original cohort of 613 children, 518 (85%) had usable MRI scans. Eighty-two (16%) had MRI abnormalities potentially relevant to epilepsy ('positive' scans). Idiopathic epilepsy syndromes were identified in 162 (31%) of whom 3% had positive scans. The remainder had non-idiopathic epilepsy syndromes of which 22% had positive MRI findings. Multiple logistic regression analysis identified non-idiopathic epilepsy and abnormal motor-sensory (neurological) examinations as predictors of a positive MRI scan. Of the non-idiopathic patients with normal neurological exams and who were not pharmacoresistant, 10% had positive MRI scans, including four patients with gliomas. Evaluations at comprehensive epilepsy centres occurred in 54 pharmacoresistant cases. To date 5% of the imaged cohort or 8% of non-idiopathic epilepsy patients have undergone surgical procedures (including vagal nerve stimulator implantation) to treat their epilepsy (n = 22) or for tumours (n = 6) without being drug resistant. Applying our findings to the general population of children in the USA, we estimate that there will be 127/1 000 000 new cases per year of pharmacoresistant epilepsy, and 52/1 000 000 childhood-onset epilepsy patients undergoing epilepsy evaluations. In addition, approximately 27/1 000 000 will have an epilepsy-related surgical procedure. These findings support recommendations for the use of MRI in evaluating newly diagnosed paediatric epilepsy patients, especially with non-idiopathic syndromes, and provide estimates on the utilization of comprehensive evaluations and surgery.
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Affiliation(s)
- Anne T Berg
- Department of Biology, Northern Illinois University, DeKalb, IL 60115, USA.
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Gaillard WD, Chiron C, Cross JH, Harvey AS, Kuzniecky R, Hertz-Pannier L, Vezina LG. Guidelines for imaging infants and children with recent-onset epilepsy. Epilepsia 2009; 50:2147-53. [PMID: 19389145 DOI: 10.1111/j.1528-1167.2009.02075.x] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The International League Against Epilepsy (ILAE) Subcommittee for Pediatric Neuroimaging examined the usefulness of, and indications for, neuroimaging in the evaluation of children with newly diagnosed epilepsy. The retrospective and prospective published series with n > or = 30 utilizing computed tomography (CT) and magnetic resonance imaging (MRI) (1.5 T) that evaluated children with new-onset seizure(s) were reviewed. Nearly 50% of individual imaging studies in children with localization-related new-onset seizure(s) were reported to be abnormal; 15-20% of imaging studies provided useful information on etiology or and seizure focus, and 2-4% provided information that potentially altered immediate medical management. A significant imaging abnormality in the absence of a history of a localization-related seizure, abnormal neurologic examination, or focal electroencephalography (EEG) is rare. Imaging studies in childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy, and benign childhood epilepsy with centrotemporal spikes (BECTS) do not identify significant structural abnormalities. Imaging provides important contributions to establishing etiology, providing prognostic information, and directing treatment in children with recently diagnosed epilepsy. Imaging is recommended when localization-related epilepsy is known or suspected, when the epilepsy classification is in doubt, or when an epilepsy syndrome with remote symptomatic cause is suspected. When available, MRI is preferred to CT because of its superior resolution, versatility, and lack of radiation.
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Affiliation(s)
- William D Gaillard
- Department of Neuroscience, Children's National Medical Center, George Washington University, Washington, DC 20010, USA.
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Vandervelde C, Connor S. Diagnostic yield of MRI for audiovestibular dysfunction using contemporary referral criteria: correlation with presenting symptoms and impact on clinical management. Clin Radiol 2009; 64:156-63. [DOI: 10.1016/j.crad.2008.08.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 07/21/2008] [Accepted: 08/01/2008] [Indexed: 10/21/2022]
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Magnetic resonance imaging findings in children with a first recognized seizure. Pediatr Neurol 2008; 39:404-14. [PMID: 19027586 PMCID: PMC2677696 DOI: 10.1016/j.pediatrneurol.2008.08.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2008] [Revised: 08/13/2008] [Accepted: 08/19/2008] [Indexed: 12/21/2022]
Abstract
This study characterized structural abnormalities associated with onset of seizures in children, using magnetic resonance imaging and a standardized classification system in a large prospective cohort. Two hundred eighty-one children aged 6-14 years completed magnetic resonance imaging within 6 months of their first recognized seizure. Most examinations were performed with a standardized, dedicated seizure protocol; all were scored using a standard scoring system. At least one magnetic resonance imaging abnormality was identified in 87 of 281 (31%) children with a first recognized seizure. Two or more abnormalities were identified in 34 (12%). The commonest abnormalities were ventricular enlargement (51%), leukomalacia/gliosis (23%), gray-matter lesions such as heterotopias and cortical dysplasia (12%), volume loss (12%), other white-matter lesions (9%), and encephalomalacia (6%). Abnormalities defined as significant, or potentially related to seizures, occurred in 40 (14%). Temporal lobe and hippocampal abnormalities were detected at a higher frequency than in previous studies (13/87). Magnetic resonance imaging and a standardized, reliable, valid scoring system demonstrated a higher rate of abnormal findings than previously reported, including findings formerly considered incidental. Practice parameters may need revision, to expand the definition of significant abnormalities and support wider use of magnetic resonance imaging in children with newly diagnosed seizures.
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Berg AT, Langfitt JT, Testa FM, Levy SR, DiMario F, Westerveld M, Kulas J. Residual cognitive effects of uncomplicated idiopathic and cryptogenic epilepsy. Epilepsy Behav 2008; 13:614-9. [PMID: 18675938 DOI: 10.1016/j.yebeh.2008.07.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Revised: 07/16/2008] [Accepted: 07/21/2008] [Indexed: 10/21/2022]
Abstract
We assessed residual cognitive deficits in young people with idiopathic and cryptogenic epilepsy. In the setting of an ongoing prospective study, we invited participants initially diagnosed and enrolled in the cohort 8-9 years earlier to undergo standardized neuropsychological assessment. Sibling controls were invited when available. We analyzed 143 pairs in which cases had idiopathic or cryptogenic epilepsy and both case and control had normal intelligence. Compared with that for siblings, the Full Scale IQ for cases was 3.3 points lower (P=0.01) mainly due to slower processing speed, which was 5.6 points lower (P=0.0004). Word reading (P=0.04) and spelling (P=0.01), but not other scores, were also lower in cases. Remission status and drug use did not influence findings. In young people of normal intelligence with idiopathic or cryptogenic childhood-onset epilepsy, substantial residual effects of epilepsy appear to be confined largely to slower processing speed.
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Affiliation(s)
- Anne T Berg
- Department of Biology, Northern Illinois University, DeKalb, IL 60115, USA.
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Arthur TM, deGrauw TJ, Johnson CS, Perkins SM, Kalnin A, Austin JK, Dunn DW. Seizure recurrence risk following a first seizure in neurologically normal children. Epilepsia 2008; 49:1950-4. [DOI: 10.1111/j.1528-1167.2008.01775.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Intractable seizures can have a devastating effect on the development of a child. In children with intractable epilepsy that is refractory to medication, surgical treatment may be needed. Magnetic resonance imaging is an essential neuroimaging tool to assist in the identification of an epileptogenic substrate. The interpretation of MR images should be done in the context of clinical knowledge of the seizure symptomatology and electroencephalographic findings. Quantitative processing of structural MR data and advanced MR imaging such as diffusion tensor imaging and MR spectroscopy have the potential to identify subtle lesions that may otherwise have been missed. In addition to lesion localization, identification of eloquent cortex and white matter tracts are also an essential component of epilepsy surgery workup. Functional MR imaging maps the sensorimotor cortex and also lateralizes language. Diffusion tensor imaging tractography can be used to map the corticospinal tracts and the optic radiations. In addition to MR imaging, magnetoencephalography and nuclear medicine studies such as PET and SPECT scanning may be used to lateralize seizure focus when clinical, electrophysiological, and structural MR imaging findings are discordant.
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Rauch DA, Carr E, Harrington J. Inpatient brain MRI for new-onset seizures: utility and cost effectiveness. Clin Pediatr (Phila) 2008; 47:457-60. [PMID: 18310525 DOI: 10.1177/0009922807313766] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Inpatient magnetic resonance imaging for evaluation of new-onset afebrile seizures can extend hospital stay, can add cost, and may not affect acute management. The study was to assess cost and impact on acute management of inpatient brain magnetic resonance imagings performed as part of new-onset seizure evaluation. Retrospective chart review of brain magnetic resonance imagings on pediatric inpatients admitted for new-onset afebrile seizure has been carried out. Seventy-five patients were identified. Seventy-one of the patients (95%) stayed an additional day for the magnetic resonance imaging. Thirteen had abnormal results. No patient had treatment changes based upon the magnetic resonance imaging results. If these magnetic resonance imagings had been done as an outpatient, the savings to the hospital could have been $215,575. Thus, obtaining an inpatient brain magnetic resonance imaging for evaluation of new-onset seizures did not lead to acute changes in management and added to facility costs and length of stay. Scheduling a magnetic resonance imaging as an outpatient could achieve cost savings without compromising care.
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Affiliation(s)
- Daniel A Rauch
- Department of Pediatrics New York University School of Medicine, New York, NY 10016, USA.
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